Application Request

2. Scotland County Planning and Zoning Department
   Fees Are Non-Refundable

   Fees Are Non-Refundable

4. Application Number

5. Receipt Number

6. Date
   Date

8. Application for
   -- Select One --Appeal per Section 6 of Ordinance 28 N/CConditional Use $300.00Present Zoning DistrictProposed Zoning DistrictRezoning $300.00Subdivision Variance N/CZoning Variance $150.00

12. Applicant

14. Address

16. City

17. State

18. Zip Code

20. Phone Number

24. Owner

26. Address

28. City

29. State

30. Zip Code

32. Phone Number

36. Attach property deed, owner consent form signed and notarized if applicant is not the owner, a copy of the appropriate portion of the Scotland County Tax Map showing location of the subject property and surrounding properties and any pertinent information to support the above request (petitions, supporting letters, etc.)

38. The request is for

40. The property is located at

42. Parcel Identification Number

44. Tax Map Number

45. Block

46. Parcel

48. Parcel Frontage

49. feet and depth of

50. feet and containing

    Square Feet or Acres

52. Indicate any impact(s) on the present area

54. Justification

56. Time schedule for development
    Time schedule for development Start Date

    —

    Time schedule for development End Date

58. I (We) the undersigned, do hereby make application and petition the appropriate Scotland County Board and certify that all statements furnished in this application are true to the best of my (our) knowledge.

60. E-Signature of Applicant *

61. Date
    Date

63. Accepted by: (Planning and Zoning Department)

64. Date
    Date

Leave This Blank:


66. 1. Receive an email copy of this form.
67. Email address

    This field is not part of the form submission.

68. Submit

* indicates a required field